Can You Stack Dental Insurance and How It Works

It is possible to have more than one dental insurance plan simultaneously, a situation often referred to as dual dental coverage. While this arrangement does not typically result in receiving double benefits for the same dental service, it can often lead to reduced out-of-pocket costs for individuals. Understanding how these multiple plans interact is important for effectively managing dental care expenses. This article will explain the common circumstances leading to dual coverage and how dental plans coordinate their benefits.

Having More Than One Dental Plan

Individuals often find themselves with more than one dental plan through various common circumstances. A frequent scenario involves coverage through one’s own employer, combined with additional coverage as a dependent under a spouse’s employer-sponsored plan. Another situation can arise if an individual holds two jobs, and both employers offer dental benefits. Additionally, some individuals might choose to purchase a supplemental dental plan to augment existing coverage.

How Dental Plans Coordinate Benefits

When an individual is covered by more than one dental plan, the process by which these plans determine their respective payment responsibilities is known as Coordination of Benefits (COB). The purpose of COB is to prevent over-insurance, ensuring that the combined payments from all plans do not exceed 100% of the dental service’s cost. This system designates one plan as primary and the other(s) as secondary.

The primary plan is the one that covers the patient as the main policyholder, such as through their own employer. If an individual has two jobs, the plan that has provided coverage for the longest period is considered primary. For children covered by both parents’ plans, the “birthday rule” applies: the plan of the parent whose birthday falls earlier in the calendar year (month and day, not year) is designated as primary. A court order, such as a divorce decree, can override the birthday rule.

Once the primary plan pays its portion of the claim, the remaining balance is then submitted to the secondary plan. The secondary plan requires a copy of the Explanation of Benefits (EOB) from the primary insurer before processing its payment. It then considers eligible benefits for any remaining amount. Some dental plans may include a “non-duplication of benefits” clause, which means the secondary plan might not pay any benefits if the primary plan’s payment was equal to or greater than what the secondary plan would have paid as primary. This clause is more common in self-funded plans and can result in higher out-of-pocket costs for the patient.

Navigating Deductibles and Annual Maximums

Deductibles and annual maximums are important financial components of dental insurance that interact specifically when an individual has multiple plans. A deductible is the amount an insured individual must pay for covered services before the dental plan begins to pay. When dual coverage is in place, the primary plan’s deductible must be met first. The secondary plan does not contribute to the primary plan’s deductible.

Each dental plan maintains its own annual maximum, which is the total dollar amount the plan will pay for covered dental services within a 12-month benefit period. These maximums commonly range between $1,000 and $2,000 and reset at the beginning of each new benefit period. When the primary plan has paid its portion of a claim and potentially reached its annual maximum, the secondary plan may then contribute towards the remaining cost, up to its own annual maximum. Certain preventive services, such as routine cleanings and exams, may not count towards the annual maximum, though this varies by plan.